Hatching a Plan | Transcript: Everything you need to know about donor sperm

Everything you need to know about donor sperm

June 30, 2024 / 01:02:37/E2

Hello and welcome to the

second episode of Hatching a Plan with me,

Simon Tomes.

and me emma the embryologist

unbelievable we're supposed

to be a professional outfit

here um so yeah we're we're

married for those that

don't know us um I have the

pleasure and privilege of

being married to emma the

embryologist and this is

all about education so for

those who are unfamiliar

with emma she does

incredible things for the

world of fertility and I'm

here to amplify you and ask

lots of questions

and today we are going to

talk about everything you

need to know about donor

sperm so first of all thank

you to our listeners we see

we have 15 people with us

today which is wonderful

and that number keeps going

up so this is great um yeah

so we're based in

teddington uk uh we're

gonna have a uk focus today

as well so there are rules

uh they're different across

the globe but this is uk focus yeah

um so yeah if you want to

share on the chat where

you're dialing in from

that'll be lovely just so

we can get to know you a

little bit and do a bit of

interaction uh with the

folks who are listening

today so oh we see a

message coming in from

sidonia hi emma thank you

for hosting the session oh

great you're more than welcome

So yeah, so stick with us.

We've got an hour and this

is how it's gonna work.

We are going to, well,

you're gonna share some

slides and run through a

lot of information in a

short space of time.

If it's all too much,

you can come back to this session again.

It is recorded.

We will post links on where

you can find that.

This will eventually turn

into a podcast called Hatching a Plan.

And we'll talk about that in a bit.

And you can come back to it.

If at any point during

Emma's webinar you have a question,

just post it in the chat

and either you'll get to it

eventually with your presentation,

or if not,

you'll jump straight in and

answer a question as soon as possible.

Ah, Vivian, welcome from Edinburgh.

Lovely to have you here.

Oh, Marianne from Georgia, US.

And we have Imogen and John,

fellow Londoners.

Ah, good stuff.

That's lovely to have you with us today.

This is great.

So just before we dive into this topic,

yeah, why are we doing this?

And I don't mean that in a flippant way,

but just like, why are we doing this?

So the short answer is

because you told me I had to.

No, why are we doing this?

Because I don't think it

should be this hard to get...

the level of information you

need to understand whatever

your journey looks like and

all the bits and the

nuances that go with it.

I don't think it should be

that hard to be able to

access really clear

information before you delve in.

I also feel very,

very strongly that people

have information to make

informed consent.

I don't think you can give

consent and I don't think

you can know what information you are

reading getting all of that

thing unless someone

actually takes the time to

speak to you and I equally

don't think you should pay

for that because you are

going to potentially

infertility treatment pay

out a lot of money and I

just don't think it should

be this hard to access

information yeah so you're

saying there's lots of unknown uh

unknowns, essentially,

when you go into this journey.

You don't know what you don't know.

And actually,

I think what gets me time and

time again is some of the

things that I think come

really straightforwardly.

And I think,

doesn't everyone know that

because it's been in my

brain for so long?

And then you tell someone

something and they're

absolutely horrified

because nobody's ever told them.

And how many years have you

been an embryologist for?

22 in October.

I know I don't look old enough.

You don't look old enough.

I really do.

So Emma really knows her stuff.

So I don't have a medical background.

I work in community and technology.

But I've lived with Emma for many,

many years.

She's such a pussy.

So I hear everything.

So I have a little bit of knowledge,

but my role for today is to

host and to ask the

questions and make sure you

as the audience feel

welcome and enjoy this experience.

I appreciate it.

It's overwhelming.

It can feel scary.

It's a lot of stuff that's like, oh,

you know, what do we need to know?

So Emma is here to help.

We've got a few more folks

dialing in as well.

So Amy from Sussex.

Hello, Amy.

Sophie from Northern Ireland.

Wonderful.

And Catherine over in Norwich there.

So welcome.

OK, and well,

shall we jump into your presentation?

Let's bring that up.

But please just fire

questions at me because I'm

going to what I'm trying to

do is it's going to be quite generic,

but I'm going to try and answer.

some of the most common

stuff that I get asked.

And donor sperm is a minefield,

to say the least.

Yeah, let's jump on in.

Excellent.

Let's do it.

So everything you need to

know to get started.

Here we go.

Okay, so probably where we should start.

Who needs donor sperm?

I think the misconception

about who needs donor sperm

is that it's single women

or same-sex female couples.

It is so much bigger than that.

It's

trans couples,

it's heterosexual couples

with a serious male infertility.

It's actually people that

have had a vasectomy, for example,

and a reversal hasn't

worked and stuff like that.

And they've met later on in life.

It's people where

there is a genetic disease

where the male partner

carries a genetic disease

and they don't want to go

down the genetic embryo

testing route so they

choose to use donor sperm

so that that there's no

risk in carrying that

disease there's also a

choice thing in this

there's some people that

are in a relationship and

the partner of that

the male partner in that

relationship just doesn't

want to be a legal parent.

So there's that as well.

So I think let's start there.

Donor sperm is a massive need.

It is a huge concept.

It's a huge need.

And there's a lot more

people than you think that need it.

And I probably import about three or four,

maybe five samples of donor

sperm a week into a clinic.

Got it.

Next slide.

Yeah, go for it.

Cool.

Oh, Mary,

Mary Anna has shared that you

must have started at age 12.

Oh, Mary, that's so sweet.

Well, your backstory, actually,

you were 15 when you went

to a fertility clinic in

Dorchester because your mum's a midwife.

My mum's a midwife.

your sister's a midwife yeah

and you there's nothing

weird about that no my my

dad was a funeral director

so I dealt with the end of

it right but you're so you

create life anyway um this

is about you so you're you

went to a clinic in

dorchester right and there

was something about that

yeah um yeah sorry there was

something about that so I

went to my work experience

in dorchester when I was 15

and I was completely

gripped and thankfully I

really enjoyed it because

otherwise I would have been

absolutely screwed doing

the job for 20 years

because I did all my

degrees based around being

an embryologist yeah yeah yeah

OK, we'll move on to the next one.

So types of donors.

So I think just to make this really,

really simple,

there are two for you as a

patient coming to this.

There are two ways that you

can access donor sperm.

There is anonymous to you.

Now,

I'm not going to use the word

anonymous very much because

you'll find out in a minute

that donors aren't anonymous.

But what I mean anonymous to

you is that you don't know who they are.

They have a code,

you buy them from a donor

bank or a depository or whatever that is,

but you don't know who they are.

Now,

the pros of doing that is that all

your testing is done,

all the legislation is adhered to.

the counseling is done,

the background checks are done,

the medical history is done.

But the cost of this,

and because of the amount

that goes into recruiting donor sperm,

it is massive.

You can pay anything between

sort of 600 and a thousand

pounds upwards per sample.

depending on the type of donor,

the availability, etc.

So there's also variable family limits,

which I'm going to get onto

in a minute because I think

it's a really important thing.

I'm going to interrupt.

Question appearing in my head already.

When you say per sample, does that mean...

you use the sample and then

you can do lots of stuff

with it or that's it the

one one on one seriously

I'm gonna get to that okay

this is good I genuinely

I'm I'm asking I genuinely

don't know the answer you

think I'm annoying to live with

okay um the only thing with

about using a donor that is

anonymous to you is they

have to consent to be used

but there has to be said

that consent can be

withdrawn so there are

there's never any

guarantees with any consent

with any couple

relationship or anything

but donor sperm is the same

um it's incredibly unlikely

that the consent will be

withdrawn because there is

a lot of counseling

involved so that's the type

of donor that you buy as a

code as a as an entity

The other type of donor is known to you.

You can actually use a donor known to you.

It can be a friend.

It can be... I've actually

done quite a lot of... So

an infertile heterosexual male couple,

with the male as infertile,

we've used his brother.

So you can use a donor known to you.

And there's some pros and cons about that.

The pros are that you are...

able to keep all those

samples for yourself you

can you only you are paying

for all the screening for

that donor and although it

sounds costly they all

belong to you and that is

one family unit which again

I'll come on to you so so

another naive question in

that scenario you just

described is the brother

the legal father no okay in

the uk absolutely not in

the uk you you hand over it

once you have donated

The legal parent, regardless,

even if it's a same-sex,

female same-sex couple,

the legal parent is the

people involved in the

treatment signing the consent forms.

When you donate something,

you donate the right to be

a legal parent.

So the surrogacy is the

thing where it's

complicated perhaps in the US.

Yeah, I'm not going to do that today.

Okay, we won't do surrogacy.

I'm not going to do that today.

So when you donate a sample,

you don't own it anymore.

It's a bit like you donating

your blood sample.

You're not going to go and

ask for it back.

Yeah, yeah.

You can't donate a kidney

and then ask for it back.

Excuse me, I've changed my mind.

can I have it back okay this

is getting really out there

already we've only just

started um so yeah so when

you donate your sample it

is um you are donating your

sample you hand over all

legal parentage rights and

you sign you sign a form to

say that it says I am not

you know this is okay

Next slide, please.

Next slide.

Sure thing.

And also if in the chat,

if you've got any questions

popping into your head right now,

because like they are

popping into my head,

please do put them in the chat.

We can bring the question up

onto the screen as well for

others to read.

And Emma, you can.

jump on in and answer anything.

But yeah, let's crack on.

So why do they donate?

Well, how long is a piece of string?

This is a really hard one.

So I used to work in a bank

where we recruited donors many,

many years ago.

And I'm going to get onto

the laws in the UK because

it's changed significantly

in the last 20 years.

Most of it was altruistic, to be honest.

And when I say altruistic, I mean,

they normally had like some

sort of background or some

sort of calling where they really,

really wanted to do this.

Abroad,

there is a little bit of financial gain.

You do not gain in the UK.

You are not allowed to be

paid in the UK for any donations,

be that blood, be that kidneys,

be that legs, arms.

You're not allowed to gain

anything from a donation.

You are allowed expenses,

but in other countries,

you are allowed to be paid

for certain donations,

but not anything that's

donated in the UK.

So there is a little bit of

financial element.

There is always the risk that it's an ego.

It's a thing about spreading your seed.

Yeah, yeah, yeah.

But let me be clear.

Donation is no small undertaking.

So it is massive.

It is such a big part of

their lives for such a long time.

They do have to make a massive commitment.

So why is that?

Why is it such a commitment?

Is it because you will

eventually help creating

like 70 families or?

Yeah.

So you're like literally

stealing my slides.

So it's because if you're

donating and so if you're

donating for one couple,

then you would your

undertaking would probably

be three samples.

You would probably give over

three samples of semen

ejaculate and then we would

break that down into, say,

12 usable samples.

But if you're donating for a donor bank.

depending on what that donor

bank is looking to get from

that donation or where they

are supplying to,

you could be donating with

that donor bank for 12 to 18 months,

and then you could be on a

recall register to come

back if they need any more from you.

So it's not a small undertaking,

it's a big deal.

So I think there are many

reasons that people donate,

but I think we need to be

very clear of how much they

have to commit to do it.

And the donor banks,

like maybe this is slightly off topic,

but I'm going to ask it anyway,

because some people might

be thinking the same.

Are they for profit or are

they funded by the

government and backed by

the government to help people?

How does it?

So a bit of both.

In the UK,

there's a couple of NHS donor banks.

But ultimately, yes, they're for profit.

They are big companies.

And the reason they charge

is because they have to

store it and the legal

stuff and all the testing.

The expense of it is massive.

But yes, ultimately, they're businesses.

Yeah, yeah, yeah.

And a clinic will pay that

donor bank via the... Can I

get onto that?

Okay, sure.

Sorry, folks, I'm getting ahead here.

But next slide.

Yeah, go for it.

Okay, here we go.

okay so what happened in the

uk so in before 2005 all

donors were anonymous and

then now this is my

favorite word which I

couldn't actually say for a

really long time the

anonymity was removed in

2005. it's like the most

ridiculous word um once the

anonymity said it twice

um was removed in 2005 there

was a massive decrease in

donations now the reason

that was removed was

because of the uh there was

a I think it was a big move

I can't remember I do

remember it happening

because I was working in

the nhs at the time and we

started trying to recruit

donors and it was it was

nigh on impossible because

there was this fear among

it but I think it came I

remember you saying it was

a real it was hard real

shift you were like oh

And before the donors could turn up,

they could donate.

I mean, go back to like the 1980s, 1990s.

Donors would turn up on the

day and do a fresh sample.

Students trying to make money, right?

And just donate.

Yeah, it was just like, that was it.

So then it got really strict

and we removed anonymity

and we had donors that were

donating for...

in the law that we've got now,

which is when the child is 18,

they can find out the last

known information of that

donor being their name and

address from what I can gather.

So that's quite scary.

It came from,

I believe it came from the

Scandinavian countries.

I'm not a hundred percent sure.

So don't quote me on that.

The donor is not allowed to

know the reverse.

Okay.

The donor is allowed to know

how many children have been

born and what genders they are,

but he doesn't get to know

who they are or where they

live and stuff like that.

Okay.

So it's really important

that when you're talking

about getting donor sperm,

especially when you're

getting donor sperm from abroad,

which is where the biggest

donor banks are,

you are dealing with donors

and it's called an ID release donor.

Okay,

now most of the banks are so good

with UK law that they will

have a British flag next to

their donors that are ID release.

And that means the donors, even in the US,

in Denmark, in Sweden,

wherever the donor bank is,

those donors have signed UK

consent forms.

Ah, okay.

I see what you mean.

So they can be shipped and

used on their database.

They know that they, you know,

they don't have to go through.

Okay.

So that was the biggest

shift in the UK law.

Oh, so a comment coming in from Mary Anna.

So for anonymous or let me

just bring this up on

screen and I'm just going

to switch the view.

So it's just come off the

slides for a bit.

So so Mary Anna,

thank you for sharing this comment.

So for anonymous,

there is a requirement to

quarantine the samples for six months,

which is also part of the

extended commitment.

Is there the same

requirement when dealing

with the known donors?

Yep, you've taken my next slide, I think.

But yes, yes, there is.

It's exactly the same.

So UK law is the same for

known donation as it is for

anonymous donation.

Like I said,

I'm using the word anonymous

loosely because it's not

really anonymous.

It is to you,

but it won't be in the future.

But yes,

so actually the UK donation laws

are identical.

So you don't actually, when you talk about

The HFEA code of practice,

which is our governing body

who have got a manifesto

that we all have to adhere to.

It is a legal document.

There is no, it's not just a suggestion.

It's an absolute thing.

The UK donation law doesn't

actually talk too much

about known versus anonymous.

It is, this is if you are donating sperm,

these are what you have to adhere to.

So is it an act in parliament?

Yeah,

it's an act in parliament that went

through in 1991 and it got

updated in 2008.

Okay, so only 2008.

So it hasn't been looked at.

No,

so the code of practice has been

changed a lot.

But I think there's been

fundamental changes in it in 2008.

But no, I mean,

it gets updated all the time.

But it's we get like alerts

when stuff have been

changed for modifications, but no,

no actual change in law, but just

So the code of practice is in law.

So as the code of practice change,

it becomes it's a rolling thing.

Yeah, gotcha.

But yes, so Marianne,

that is that is true for all we don't,

we don't really have a

difference between known and anonymous.

Everyone has I have the same

guidelines to follow

whether I am screening for a

a donor that I'm going to sell,

which I don't do myself,

but I have done before,

or a donor that we are

going to keep for a

specific patient who has

bought this man for her own donation.

Yeah.

Yeah?

Yeah, yeah.

Great, great comment and question there,

Mariana.

Thank you.

So let's bring up this one

from Sarah Jane.

Can donors approach the

sperm bank in 18 years time

to find out the address of born children,

if that makes sense?

No, they can't.

So no.

They can find out how many

children have been born and

what gender they are, as far as I'm aware,

but nothing else.

That's as far as they can go.

They're not allowed to hunt them down.

And I guess from the

altruistic side of thing,

that person can then just feel good.

Like, oh, I've helped 20 families.

Like that's, that's where they go to.

Yeah.

Or I've helped 30 families

or I've helped 10 families.

Isn't that cool?

Yeah.

Brilliant.

Yeah.

Good question there, Sarah Jane.

Thank you.

Should we jump back to the slides?

Cool.

So bring that one off and then.

I think the next one's UK law as well.

So that's why I was saying all donors,

regardless of where they come from,

have to sign our HFEA forms

and adhere to screening rules in the UK.

What's in a screening rule?

It's next slide.

Oh my goodness,

this is like quite painful

working with you this evening.

um okay so um all all

persons using donor sperm

so if you are receiving

donor sperm you have to

have implications

counseling it's mandated

again that's in the code of

practice and all donors

have to have counseling so

if you are donating you

have to undergo counseling

so so counseling is a big

word just very briefly what

would counseling include for the donor

So it's called implications counselling.

So it's implications of what

your donation is meaning.

So they're fully aware of the risks?

Yeah,

but actually a lot of the donor banks

now do,

obviously there's a lot of medical

history checks and stuff.

And actually the counselling is more,

I think from experience,

they actually have quite a lot of,

like mandatory conversations

as they go through the

recruitment process to make

sure that they're doing it

for the right reasons,

to make sure their mental health's intact,

all of those things.

And they have to have

implications to understand

what this means for them in

18 years time.

And if you are receiving donor sperm,

you have to have

implications counselling as well.

If you are bringing a known

donor to the clinic,

you all have to have group counselling.

So you have group counselling,

single counselling, single counselling.

There's a lot of it involved

and it's all mandated.

And so you can't go, no, not doing it.

And if you say, no, not doing it,

then you can't go.

You can't use it.

Okay, got it.

And for the mandated for any

person using donor sperm, is it, again,

just implications?

You used the word implications.

So people letting themselves

know what they're signing up for.

Sophie's asking me a

question that we'll get to in a minute.

Yeah, let's get... Yeah,

should we get Sophie's question up?

No, because I'm going to go to screening.

Oh, okay.

So I think I'm going to

cover Sophie's question in a minute.

Okay.

Screening!

Hey, there we go.

This isn't all of it, by the way.

This is like just to give

you a ballpark of what we

have to screen donors for.

So in the HFEA,

there are mandated screenings,

there are ethnic screenings,

and there are screening

that is being done by

certain donor banks as...

extra plus or minus too much

and that's that's very much

an opinion and a choice and

all of those things so

mandated by the hfea is

every donor must be

screened for all virology

so hiv hep b hep c they

must be screened for

gonorrhea chlamydia they

are also screened for the

carrier status of cystic

fibrosis because it's so

common in the population

they have a carrier type

which is to check that all

their chromosomes are in order

They also have CMV,

which is what Sophie's talked about.

And they have we do other

things like we check

infection in the semen and

there are other things.

But there's a whole list on

the HFPA code of practice

that is very much every

donor has to have this

before they donate.

Now, before they donate is.

is a bit loose so legally I

have to have hiv hep b hep

c hep b core before I store

I am not allowed to put any

samples in my tank before I

have those results oh of

course cystic fibrosis

karyotype cmv all the

others you can wiggle a bit

you can do them later but

you cannot use any donor

sperm I'm I suppose in my

head I'm thinking about a

known donor situation yeah

you can't use any known

donor sperm until you have

all those results and it's

been in quarantine

And you put them in a

separate tank for

cross-contamination risks

and all of that stuff?

Yes.

Okay, gotcha.

So in answer to Sophie's question,

CMV is cytomegalovirus.

Now,

I have a particular bugbear about

cytomegalovirus and I have

to put my filter on a bit

here because as people that know me know,

I don't have one.

Cytomegalovirus is a bit like chickenpox.

It's something that you

generally catch as a child.

It's like a common cold.

It's not a very nice virus.

The reason they talk about

it so much is because it's

absolutely tragic in pregnancy.

If you catch CMV in pregnancy,

it can be catastrophic to the pregnancy.

In all fairness,

it's the same as if you

catch chickenpox in pregnancy.

It's the same as if you

catch herpes in pregnancy.

All of these things are part of the...

the herpes varicella family

and they are really really

bad the problem I have with

CMV is we are told to

encourage patients that if

they are CMV negative so

most patients have

screening themselves before

they pick a donor okay so

if they're CMV negative

they should try and choose

a CMV negative donor I

can't understand that

because a CMV positive

donor does not have CMV it

means that he has had it as

a child because we do two

tests we do what's called

an IgG and an IgM

The IgM is for current

infection and the IgG is the,

or is it the way around?

I'm not a virologist,

I'm not gonna pretend to know.

One of them is for current infection,

one of them is for you have had it,

but you are not currently infected.

So you would never allow a

donor to continue to donate

with a current infection.

And because we know the difference,

we would say, well,

you've got a current infection,

you can't use those donors, right?

So my question to anyone is

how can someone who has had

CMV as a four-year-old give a woman CMV?

The answer is it's a theoretical risk.

It's never happened.

I can't see it ever happening,

but we are told to donate.

encourage you to pick a CMV

negative donor if you are

CMV negative I find it

mind-blowing that it hasn't

been removed but that is

what CMV is and that's what

Sophie is asking so I'm I'm

very much I sit in a clinic

now where we are doing the

guidelines we're sharing it

but it's not mandated you

can choose a CMV positive

donor and sign a waiver

because it's it's bonkers

if you ask me yeah you

can't give some it's like

me trying to give you

chickenpox I had chickenpox

when I was three years old

yeah I can't give you chickenpox so

i I don't get it I'm sorry I

don't get it anyway good

bit of honesty and and

sophie hopefully that has

helped answer your question

if you've got a follow-up

to what emma's just shared

then please do jump in the

chat and let us know um and

sarah jane thank you for

sharing um yeah we had our

implication counseling on

friday oh wow there you go

very recently counselor

just asked key questions

yeah uh ethical based ones

mainly was interesting okay

yeah it's really

interesting sharing that um

I've sat in on a couple of

them they're really good yeah

Back to the slides.

Back to screening.

So quarantine means a period

of time that has to pass

before you can release the

samples for use.

Now, Mary Jane said six months.

You can actually release

samples a bit earlier than

that if you're going to do

what's called NAT testing.

So there's two types of testing for HIV,

Hep B, Hep C, Hep B core.

You can either do antibody testing,

which is really effective,

but you then need a

six-month window to make sure.

The reason you have to have

these quarantine periods is

because the HIV, for example,

can take up to six months to

show up in the blood.

So once you're frozen a

sample and someone was then

to contract it, say, that day,

it wouldn't show up for six

months on a certain test.

There is a different test

called NAT screening that

we use in the UK,

and we release samples

after three months because

it's much more...

It's just more sensitive to HIV, Hep B,

Hep C and Hep B core.

So you can release samples

after three months,

but every sample has to go

through a period of quarantine.

So if you are thinking of

recruiting a known donor, for example,

you always have to factor

that into when you can use the sample.

So you're planning as far

ahead as six months.

You have to plan six months.

However,

if you're buying from a donor bank,

they will only release

samples to you once they're

out of quarantine.

They will only sell samples

that are out of quarantine, right?

So that's another one of

the... So the difference

between knowns and anonymous.

Yeah.

Okay, got it.

So if you're buying from a donor bank,

they are only selling what

has come out of quarantine.

They're not... They might

actually... If you really

wanted a donor and it's on their books,

but they've sold out of what... Like,

by the by...

it's a little bit like a catalogue.

They might say to you, I have got some,

but it's in quarantine for

another three months and

you can reserve some.

But he then has to have all

those bloods cleared.

And if those bloods don't

come back cleared,

those samples are destroyed.

And maybe because you don't

work in a donor bank,

but when you reserve,

do you literally pay a deposit and say,

right, I want to reserve that?

It's really different.

Different donor banks do different things,

yeah.

Fair enough.

And I think you're going to

share some example donor

banks a little bit later.

Yeah, yeah, yeah.

Okay, cool.

OK.

All right.

Next one.

So what do you find out about the donor?

Now, this is really,

really one of the biggest

questions I get asked.

And actually,

a lot of this is personal choice.

So especially in the UK,

you will not find out a lot.

The donor banks in the UK,

a lot of them are still in

the NHS or if they are, if they aren't,

it's not.

it's not quite the same as

buying from abroad so you

will find out hair color

eye color height you have

lots of background

information about them

you'll find out their

education um you might get

what's called a pen sketch

whereas the donor tells you

like might do a little

writing about themselves

and they might do that in

their own handwriting

that's encouraged um but

actually you get quite

limited information in the

uk blood group you get that

you get um again it depends

but you're not going to get

pictures in the uk from the

uk donor banks now if you go abroad

It's almost the sky's the

limit and you can actually

choose not to see it because you,

the donor banks are very

good at putting up the front information,

but you can then pay into

behind the paywall and you

can start looking at baby

photos of pictures and

teenage photos of these

guys and you can see pictures of them.

Oh my goodness.

So this has become the real

problem with the word

anonymous because now we

have AI and generations and all that,

and you can stick someone's

picture into Google and it

will come up with who that person is.

So it's a really challenging time.

However, it's not illegal.

So I always say to people,

how much do you want to know?

Because actually you get to choose that.

Okay.

Now a question back to you about that,

because that is utterly fascinating,

particularly where it's

much easier to find people

online if you dig a little deeper.

how what percentage of

people say I want to know

everything as much as

possible this and I ask

this question like you know

it's all anonymous but it's

more to for our audience

like how how comfortable

they feel about it and

You know, yeah.

So interestingly enough,

it's the demographic of

patient that wants to know more or less.

So generally,

if it's a heterosexual couple

where the man is infertile and tragically,

they've probably been

through a huge amount to

get to where they are now.

And they found out that

there is going to be no

possibility of conception,

like for a genetic disease

or for what we call azoospermia,

which is.

no sperm seen at all for

lots of different reasons

like when you get mumps as

a child or something like

that they don't tend to

want to know a lot actually

I think it's easier not to

and this isn't a black and

white answer by the way

this is just my general

what I've seen over the

years yeah and that's my

question whereas single

women same sex female

couples are very much more

want to know everything um

probably to get more

control over it yeah which

is again it's just an

observation absolutely yeah

um I don't think there's a

right or wrong answer to

this actually I think it is

very much but I think it's

really important that

you're comfortable with

what you see and what you don't see

So it really comes down to

personal choice and the

individuality of that

individual or that couple.

So also you can find out if

they've had previous pregnancies.

Some of the donor banks,

some of the donors have

been donors for a really long time.

So I might say that they've

got proven fertility.

and that I guess is is

awaiting like oh okay if

they've had success in the

past then it's more likely

that it will be successful

yeah but equally that

wouldn't put me off because

a lot of the donors that

donate abroad are quite

young so they won't have

had their own families oh I

see and they might not have

been used that much and

actually they're incredibly

well screened so I don't

think it would be the

reason I didn't know the

stats don't really matter

at that stage if it's like

someone in their early 20s or mid-20s

Yeah.

And this could be the first

time that and you've got to

remember the donor banks

are tracking it as well.

Yeah.

So they don't want to be

selling a donor that's not

making pregnancies, right?

So they will be tracking the

first 10 sales that they do

to and then getting

feedback from that as well.

Yeah.

Wow.

And so so the donor banks then go, right,

well,

this this person is not having success,

and they literally take

them off their books.

I think they probably investigate it.

But yeah,

it would have to be quite I've not,

I have seen it once, actually,

but it's many, many years ago.

As in, they went,

this donor's just not good enough,

and they're not having any success,

and therefore... It was in the UK,

but yeah.

There you go.

We never really did catch the bottom of it,

but there's always going to

be those ones that look okay on analysis,

and then...

The reality is different.

Yeah.

But that's a smaller percentage.

Tiny, which is why it wouldn't be my,

if I was choosing a donor

and people say to me quite a lot,

should I be looking for

someone with proven fertility?

I think you need to,

like what I will say is the

donor banks that we work with,

which I will name a few

just because I think it's

really good to have a view

of what's out there.

Most of them will have

someone at the end of the

phone that actually knows

these guys and they'll be

able to tell you a little

bit more about how long

they've been donating and

actually if it's a worry or

if like all of those,

they're actually really

good at communicating with you.

Yeah, they know these people.

They don't want you to feel

like this any more than you do.

Yeah, that makes sense.

Okay,

so let's just jump onto the chat to

see if we've got more stuff coming in.

Oh, yeah, good stuff, Sophie.

So thanks for answering the CMV question.

That's put me right at ease.

Oh, good to hear that.

And Sarah Jane also, CMV question,

the same as Sophie, I wanted to know too,

was fab.

brilliant um okay emma also

nature nurture debate comes

into play when choosing

donor sperm it did for us

anyway yeah absolutely I

mean it's so true yeah it's

so true and actually um I'm

a big believer in nurture

over nature to be honest I

think that there are

certain things that nature

absolutely plays a key role

in but ultimately you're

bringing that child up and

that's it's that's where

all your mannerisms come

from it's not from yeah I'm

a massive believer in that so

Absolutely.

Okay, let's bring up this from Sophie.

So we're doing treatment in

Southern Ireland and you

get everything and then

some extra when it comes to

knowing about the donor.

My husband has azoospermia

due to the mumps.

And we have gone through to

wanting an anonymous donor,

to wanting to a known donor

with all the information.

The process is a whirlwind.

Thank you for sharing that, Sophie.

So it's interesting you talk

about Ireland because

obviously Northern Ireland

is part of the UK,

so they come under the HFEA.

Ireland doesn't.

Of course.

So Ireland still have access

to anonymous donation,

which actually when you're trying to ship,

which I'll come on to in a bit,

when you're trying to ship

sperm between countries,

it can be quite challenging

because of the rules and stuff.

So especially when it's Ireland,

because it's so close.

Of course.

And actually their rules are

quite different.

Yeah.

Exactly what you say.

You go through waves of emotion, I think,

especially when you are in

a situation like you are

with azoospermia caused by mumps.

You go through waves of what

you want to know and then

how much more comfortable

you get with that process.

I think it changes.

And that's why I think

counselling is so key.

And I don't think it should

just be the mandatory stuff.

I think in situations like Sophie's,

it should be extensive and

I think actually should be funded.

yeah and and the point being

how you might feel in one

month can feel completely

different in month two yeah

and I get more you get more

comfortable with it a

little bit yeah yeah yeah

yeah thank you for sharing

that sophie I really

appreciate it um and a

comment from amy so my

husband wants to use a

donor that's the same

similarity so we like to

choose from photos yeah but

we are debating whether to

see adult photos of the donor

So again,

I would speak to the donor bank

that you're looking at.

If you find someone that you like,

it could be that the donor

bank will help you with

what photos you can and can't access.

I don't know, and I can't comment,

but I know that there's the

option to see children's,

like the child photo rather

than the adult photo.

Whether or not that can be split up,

I don't know.

But I would definitely get

in touch with them and be

really honest about what

you're struggling with.

And they can help you.

They're really good humans.

So, you know.

And just to add, Sarah, Jane,

appreciate you sharing this advice.

Amy, check out the European Sperm Bank.

We could hear our donor's

voice and see a pen sketch

of him as a grown-up and

saw baby pictures.

We also have free shipping

off at the moment.

We bought our sperm on Friday.

Well, that is new to me.

You just taught me.

I knew the donor voices were coming.

I didn't know it was out, actually.

Oh, wow.

Fascinating.

So yeah, it's getting,

it's getting different.

It's changing.

You know,

the landscape is changing and I

think it is very much about

how comfortable you are, but this,

the reason I'll be doing

this is to make sure that

you're aware that this is

what's coming because

actually there can be a lot

of shock involved in this.

Oh my God.

I wasn't expecting to see that photo.

Of course.

Yeah.

Okay.

Let's move back to the presentation.

Next slide.

How much do you need now?

This I can honestly say is

the most common question I get.

How much do you need?

I mean, yeah.

So if anyone,

and everyone here must follow

me on Insta because

otherwise you wouldn't have

known about the webinar

unless you've come from LGBT mummies.

But ultimately on my webinar,

on my Instagram last night, I put

let's talk about family, not just baby.

So when I talk to patients

about donor sperm and how much you need,

I'm constantly talking

about the need to think

bigger than the now.

Donor sperm is,

is not an endless supply.

And the worst thing I have

ever seen in my career is a

couple that came through,

used donor sperm, had a child,

and then there was nothing

left for a sibling,

and they had to then go to

a different donor for a sibling.

And the trauma that came with that,

is was massive so um sarah

raises a very good point

there how much can you

afford 100 and that's why I

think it was interesting to

put up the anonymous versus

known how much it all costs

which I'm going to get onto

in a minute but ultimately

the question you ask is how

much do I need yeah so one

sample is one cycle of treatment

So most people come to this,

depending on what

circumstances they're in,

thinking about doing IUI donor.

So IUI donor is insemination

with donor sperm,

and the success rates vary

depending on the age of the

woman being inseminated,

but it ranges from 8% if

you're in your late 30s,

to 15 if you're under 35

okay so on average it's

going to take you three or

four cycles of iui

potentially to have that

first pregnancy and that is

four vials of donor sperm

four vials or straws we

straw we either freeze them

in vials or we we freeze

them in stores depending on

where they come from it

doesn't really matter it

doesn't make any difference

to the quality of the sperm

it's just how they're

stored so by then you've

already gone through four

and then you've potentially

got to buy another four

because you might want a sibling later on

or you can reserve another four.

So how much you need is what

are you planning on doing with it?

So if you think that, like I said,

if you think about children

and all of that,

so a lot of donor banks

will allow you to buy a

group of sperm and ship it.

And some donor banks will

allow you to reserve some

and keep it in their bank

so that if you don't use it,

they'll buy it back or

they'll give you a partial refund.

Something like that.

Once it has left their clinic,

they won't buy it back.

Understandably,

because they don't know

what's happened to it.

Yeah, of course, they can't risk.

So there's that option.

But I will say that one

round of IVF where you

collect lots of eggs,

we only use one vial of donor sperm.

Just say that again.

So one IUI,

so one insemination where there

will only be one or two

eggs because you're using a

woman's natural cycle, right?

That will be one vial of one

straw of sperm.

Yeah.

One round of IVF where you

collect lots of eggs, one vial.

One treatment, one sample.

Yeah.

Okay.

All right.

So let's cost it out.

Yeah.

If you are looking between

8% and 15% per treatment cycle,

depending on age,

and you need four rounds or

three rounds of IUI,

by the time you've done

three rounds of IUI,

you've spent approximately 7,000 pounds.

Because you've done all the IUI treatment,

all the scans, all the lead up,

all of that, and you've bought your sperm,

right?

But you've had three goes,

and essentially you've

probably released three, maybe four,

maybe five eggs.

With me?

Yep.

100%.

Yep.

IVF, you do one cycle of treatment,

you collect lots of eggs.

When you say lots, what do you mean?

Well,

it depends on your personal

circumstances.

Between 5 and 25,

depending on your own

personal circumstances.

And in fact,

IUI for some people may be

better because they're not

going to collect any more

eggs than they would in an IUI.

That's a completely

different conversation I

haven't got time to get into.

In most people coming to

this at their mid to late 30s,

they will collect a

reasonable number of eggs.

My average number of eggs at the age of 36,

37 is 14.

that I collect in a cycle of IVF.

You then fertilize all 14 eggs,

or try and fertilize all 14 eggs,

with one vial of sperm.

And not only can you have

embryos to put back and have a baby with,

you've got embryos in the freezer.

And that is about 8,000 pounds.

So the question has to be, yes,

this is all a great idea if

you're gonna have one cycle

of IUI and it's gonna work,

but we need to get our

percentages in order.

Because actually when people

say it's cheaper, I'm gonna do IUI,

Is it?

Yeah.

And to your point about

think beyond the now,

think family over baby,

then I can understand why

you encourage people to think,

just think beyond the initial cost.

Yeah.

It's beyond that.

Because it's bigger than that.

So I always urge people to say, yes,

in an ideal world,

I'd love you to have one

IUI for this baby and one

IUI for that baby.

But the realistic value of

that is that's just not how it happens.

yeah I get it so that's

fascinating but one sample

per treatment regardless of

that treatment yeah got it

if you have a question

about costing please go for

it in the chat appreciate

when it comes to numbers

and how much things cost it

can get quite confusing and

overwhelming I think

someone asked a really good

question up here and I

think we missed it oh did

we miss it okay let's have

a look this one

Okay, so let's bring this question up.

Yeah, apologies, Sarah Jane,

for missing this one earlier on.

So the question is,

we are using donor sperm,

but they made me complete

blood tests too.

Female profile for HIP, HEP, etc.

Why is this?

Seems strange because we are

doing IUI with donor sperm.

I would understand if we had

to create embryos.

Because IUI donor is a licensed treatment.

So with a licensed treatment,

so there's treatments that

we can do in the clinic

that aren't licensed.

So IUI partner is not a licensed treatment,

but IUI donor is a licensed

treatment governed by the HFEA.

So the same screening rules apply.

So when we are performing a

licensed treatment,

we have to have virology for both parties,

regardless of what we're doing.

I hope that helps.

But it's licensed.

It means we are regulated on it.

Yep.

We're not regulated on time

sexual intercourse.

We're not regulated on

ovulation induction.

We're not regulated on IUI partner,

husband,

because you're having intercourse anyway,

but we are regulated on IUI donor.

I see.

Yeah.

Hopefully that helps answer

your question there, Sarah Jane.

Thank you for asking.

And sorry,

we missed it a little bit earlier on.

Okay.

Let's bring that one down.

Okay, the acronyms.

So when you go onto any donor website,

what they're going to say,

it says things like IUI and

ICI and ART and MOT20 and MOT10 and ICSI.

Oh my goodness,

how is anyone meant to understand this?

So different donor banks

will do different things.

Ultimately,

what I'll tell you is that in a

clinic that we work in,

because the reason that the donor banks,

they don't tend to do this in the UK,

you tend to just get unwashed

or what we call ICI sperm.

ICI stands for

intra-cervical insemination.

It's unwashed, it's raw semen,

and it's just cryopreserved.

That's how we preserve most sperm.

In donor banks across the world,

you've got to remember that

they are able to send donor

sperm to doctors' surgeries

for insemination.

They do not need to go into

a fertility clinic in certain countries.

In the UK,

all treatment with donor sperm

has to happen in a

fertility clinic under a regulated body.

That is not the same in the

rest of the world.

So they are catering for the whole world.

So you will pay different

values for different things.

So an IUI sample is a washed sample.

It means it's already been washed out.

An ICI or an unwashed is

actually what I would

prefer because I'm going to

wash it anyway because it's

part of my process in my laboratory.

Yeah.

An ART and ICSI sample,

these might be cheaper

because they're just lower motility,

but you can more than

happily use them if you're

going to do egg collection and ICSI.

And the MOT20, MOT10,

it actually means how many

million motile sperm there

are in it after thawing.

So all of these things are options,

but I would speak to the

people that you're,

like when you know what

treatment you're having,

speak to the embryology

team because I'll tell you

exactly what to buy.

I got it.

So we have a question from

Sarah Jane again.

So thank you, Sarah,

for keep the questions coming.

This is great.

So with that,

to follow up on the previous point.

So would that mean an IUI

IVF baby is a safe way of conceiving?

And there's a follow up question here,

meaning less risk of disease.

No, there's no evidence for that.

So IVF, ICSI, all of those things now.

was a paper that came out in

2012 that's actually been

slammed a bit recently

because um going back to

when anonymity and I see I

told you I can't say it

it's a strong anonymity was

removed in 2005. the reason

they did it in 2005 is

because ixi had become this

really big thing so we were

actually using less donor

sperm because we were able

to treat more infertile men

yeah so they did it at that

stage where it was its

lowest use because they

were trying to impact like the less

In 2012,

a paper came out saying that IVF

and ICSI babies were

exposed to more disabilities.

You have to understand that

back in the day,

the ICSI babies that we

were using ICSI for back in 2010, 5,

six seven eight nine ten

before that paper was

published we were treating

the most infertile men with

ICSI right so you can't

question sticking a needle

in an egg you have to

question why were they in

why did they have such a

low sperm count in the

first place and a lot of it

is genetics if you did that

test again now with the way

we do fertility now and

people have done it there

is no difference between

natural conceived babies

and IVF and ICSI babies I see

The risk is the risk.

It's the same.

So no, I don't think that's,

it's not a thing anymore.

Okay.

Good question there, Sarah-Jane.

And another question coming

in from Samantha.

My IVF clinic makes you send

two over for one cycle in

case one has an issue.

How do you handle that as

you have to buy more,

which may not be used?

Depends what treatment you're having,

Samantha.

I think that's really mean.

I think if you were doing

IVF with your donor sperm

and we had prepared you for

the fact that on the odd

occasion it might not make

it to a good enough sample for IVF,

I would convert to ICSI

without any qualms at all.

I would have that conversation with you.

So yeah, she said she's doing IVF.

I would have the

conversation that if it

doesn't prepare well enough

for IVF you're happy to do

ICSI because if you look at

the cost difference there

you're talking about two

vials of donor sperm which

is actually quite a lot of

money and quite unnecessary

unless you're going to keep

that second vial for a

future cycle and I don't

think that's obviously what

we talked about earlier

about sibling use so I

think there's conversations

to be had there and they

just need to be a bit you

know work with you rather

than mandating stuff I

would never mandate someone

has two vials if they

understand that I might

need to convert to ICSI

Yeah.

Hopefully that answers your question,

Samantha,

and keep the questions coming if

you got any follow up on that.

Okay.

So I think I've gone through quarantine.

So I think we're clear on that.

The reason I want to skip on

to the next one is because

I've actually got a couple

of really important slides

and I'm running out of time.

As always, I talk too much.

Families.

Right,

this is a really big one that nobody

knows to ask and nobody

should ask and all of those things.

In the UK, every donor,

whether it's created in the

UK or being shipped in the UK,

is only allowed to create 10 families.

That does not mean 10 children.

That means 10 family units.

Ah, okay.

So one family can have three children.

They're still a family,

so they'll be brought up as siblings.

Yep.

So most of the UK donor banks,

as it stands,

do not have enough donor

sperm to ship out of the UK.

So most of it is kept in the UK, right?

So there are donor banks

throughout the UK.

A lot of donor banks keep

their donor sperm in house

because it brings patients to them.

I understand that there is a huge shortage,

right?

So in the UK,

you are only allowed to

create 10 families from a donor sperm.

If donor banks are shipping into the UK,

for example,

the European Sperm Bank or Zytex or Cryos,

they are only allowed to

ship in to 10 people for 10 families.

They sell it as a pregnancy slot.

But that does not mean that

they are only creating 10 families.

There are some donors that

have 75 families worldwide.

Because they're beyond the UK.

Beyond the UK because

they're selling it everywhere, right?

Yeah, I got you.

Now,

some donor banks will limit the family

of a donor and make you pay more for it.

Some donor banks are quite

open and will say this is a

50 family limit.

But these are the questions

you need to ask.

Is the donor you're being sold,

what is his family limit?

It'll only ever be 10 in the UK.

Categorically, it's against the law.

But how much further reaching is that?

Because I think a lot of

people need to get their

head around that.

But how do you ask that?

How do you find that out?

You just have to ask them or

they just tell you?

No,

the donor bank should have a family

limit.

But if they don't talk about it,

then your recommendation to

the audience today is to ask.

Just ask, what is your family limit?

For this donor.

They will have different family limits.

Across the globe.

It will only ever be 10 in the UK.

They can't sell anymore.

Yeah.

And if they say otherwise,

then you're like, oh, hang on a minute,

you know, you can't.

Yeah, they can't.

Yeah, legally they can't.

So they only sell it 10 times into the UK.

So you encourage... Unless

someone doesn't have a

child or any more embryos with that,

and then that person can

release that pregnancy slot

and someone else can buy it,

if that makes sense.

If unsuccessful.

Unsuccessful, yeah.

Ah, okay, so they report back and... Yeah,

yeah, we report back.

Oh, of course, you report back.

Yep, I understand, I understand.

So family limits is a really,

really big thing that I think people,

there are now donor banks.

I have certain opinions

about this as I do about everything.

Of course.

About exclusive donor

packages that are costing

extortionate amounts.

And I'm finding that hard to

get my head around.

I'm not going to say any

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